Socioeconomic status as a risk factor for late presentation of glaucoma in Canada

Objective: To evaluate the effect of socioeconomic status on late presentation of glaucoma. Design: Prospective, multicentre, cross-sectional study. Participants: Newly diagnosed open-angle glaucoma. Methods: Eligible subjects with newly diagnosed open-angle glaucoma underwent a comprehensive ocular examination and were classified as mild, moderate, or advanced according to the Canadian Ophthalmological Society glaucoma guidelines. Socioeconomic status was estimated by linking the subjects' postal code to the median household income in the 2006 Canadian population census at the level of dissemination areas. Five equal income groups ranging from the lowest to the highest income quintile were considered and compared regarding the frequency and proportion of moderate or advanced glaucoma. Results: A total of 290 subjects were included in the analysis; 151 (52.1%) had mild, 79 (26.9%) moderate, and 60 (21.0%) advanced disease at initial diagnosis. Patients with newly diagnosed glaucoma were less likely to come from the poorest neighborhood areas (16.21%) when compared with an expected one fifth (20%) of patients presented in each of the 5 social economic groups (P = 0.56). Compared with people from the poorest neighborhood areas, people from the richest neighborhood areas had a marginally lower risk for having moderate or advanced glaucoma at first presentation (prevalence ratio 0.66, 95% confidence interval: 0.43-1.02, P = 0.06). This association was stronger among those >65 years old (P = 0.006). Conclusions: To the best of our knowledge, this is the first study in Canada to provide evidence that socioeconomic deprivation is associated with greater severity of glaucoma at presentation, specifically for those >65 years old. Consideration should be given to targeting poor neighborhood areas for glaucoma education, screening, or both.